Clinical Focus Volume 7 N3

Editor Admin

Eye problems account for 4.5 million GP consultations yearly, in the United Kingdom, and evidence shows that 50% of sight loss could be avoided through improved eye care and early detection. While often it is obvious when an eye condition needs referral (for example the red, painful eye, or sudden loss of vision), there are a number of potentially blinding or even lifethreatening conditions which may present atypically or with subtle signs that may be missed. Such misdiagnoses can have serious implications.

This article examines common presentations in ophthalmology and suggest some important ‘red flags’ in each which merit urgent attention. We have placed emphasis on conditions which can be life or sight-threatening, which can present atypically, and whose ‘red flags’ are aspects of history or examination which are easily and quickly elicited in the GP consultation.

It is worth noting that while many of the conditions discussed frequently present with eye symptoms (and indeed may be seen in eye casualty), they may in fact reflect other underlying disease processes (e.g. raised intracranial pressure). Having the conviction to refer such patients directly to the medical or neurology team for treatment results in a safer and faster patient journey.

Perianal dermatoses and pruritus ani are common and socially embarrassing conditions that are often poorly managed. Perianal dermatoses encompass a variety of inflammatory diseases affecting the anal region, of which eczema, of various aetiologies, is the most common.

Pruritus ani is a chronic itch of perianal skin without rash and is poorly understood. There is a knowledge gap in understanding the pathophysiology and management of pruritus ani as there has been little research.

The aim of this article is to present an overview of perianal dermatoses and their management.

Hip pain is a common presentation in GP practices across the country. It can be caused by a multitude of different pathologies ranging from simple muscle spasms, to fractures. It is vital that health professionals can differentiate between benign causes, which can be treated in the community setting, to symptoms that warrant specialist input.

Depression is a common mental health disorder in children and adolescents and presents relatively frequently to primary care. Early recognition, assessment and treatment of depression is important to alleviate distress, improve functioning and later outcome, and manage risks. Primary care and tier 1 professionals may manage mild depression whilst moderate to severe depression is usually managed by specialist mental health services. Treatment of depression is dependent on severity and individual circumstances; interventions include supportive measures, addressing stressors, psychological therapy, and antidepressant edication in selected cases.

Primary care professionals are amongst the most frequent users of the National Poisons Information Service in the United Kingdom. This paper provides an up-to-date review on the management of acute poisoning in this setting.